302015Apr

Therapist-Patient Bond Can Make or Break Psychosis Treatment

In patients suffering from psychosis, the relationship with their therapist is one of the most important factors for effective treatment. In fact, this relationship can either improve or damage a patient’s well-being, say researchers at the University of Manchester and the University of Liverpool.

Many studies have evaluated different types of talking treatments — such as cognitive behavioral therapy (CBT) and family therapy — which can help people recover from psychotic episodes. High quality research also incorporates a comparison group which would receive some kind of less structured treatment, such as supportive counseling or befriending.

Surprisingly, patients in these comparison groups often benefit from the comparison treatment just as much as those receiving the specific, targeted therapies (CBT or family therapy). Both groups who receive a psychosocial treatment fare much better than those who are given only medication and usual care.

The new study, which involved the evaluation of over 300 people with psychosis, found that it is in fact the quality of the relationship between the therapist and patient that causes improvement and not the different techniques employed in either type of therapy.

The researchers explored in depth the causative effect of the “therapeutic alliance” or relationship of trust between patient and psychologist when patients with schizophrenia were treated during a trial of this kind.

Lucy Goldsmith, a Ph.D. candidate from the University of Manchester’s Institute of Brain, Behaviour and Mental Health, carried out the research in collaboration with the researchers who had carried out the original trial: Manchester professors Drs. Shôn Lewis and Graham Dunn, and Liverpool professor Dr. Richard Bentall.

“The quality of the therapeutic relationship has been linked to outcomes before, but we wanted to see whether it really causes the changes in well-being occurring during therapy,” said Goldsmith.

“Does successful treatment make patients feel well disposed towards their therapist or is the relationship actually at the heart of whether therapy succeeds?”

The findings showed that a good level of therapeutic alliance had a beneficial impact on well-being, but where the relationship was poor, the treatment could actually be damaging.

“The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate,” said Goldsmith.

“More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued.”

“The study clearly shows that the two types of therapy are equally beneficial to the patient — as long as the trust, shared goals and mutual respect between client and psychologist are in place.”

The study is published in the journal Psychological Medicine.

Source: Manchester University